scholarly journals First-Phase Ejection Fraction, a Measure of Preclinical Heart Failure, Is Strongly Associated With Increased Mortality in Patients With COVID-19

Hypertension ◽  
2021 ◽  
Author(s):  
Haotian Gu ◽  
Chiara Cirillo ◽  
Adam A. Nabeebaccus ◽  
Zhenxing Sun ◽  
Lingyun Fang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Proportional Hazards ◽  
Clinical Laboratory ◽  
Strong Predictor ◽  
Cox Proportional Hazards ◽  
Reactive Protein ◽  
Proportional Hazards Regression ◽  
Early Systole ◽  
Union Hospital

Presence of heart failure is associated with a poor prognosis in patients with coronavirus disease 2019 (COVID-19). The aim of the present study was to examine whether first-phase ejection fraction (EF1), the ejection fraction measured in early systole up to the time of peak aortic velocity, a sensitive measure of preclinical heart failure, is associated with survival in patients hospitalized with COVID-19. A retrospective outcome study was performed in patients hospitalized with COVID-19 who underwent echocardiography (n=380) at the West Branch of the Union Hospital, Wuhan, China and in patients admitted to King’s Health Partners in South London, United Kingdom. Association of EF1 with survival was performed using Cox proportional hazards regression. EF1 was compared in patients with COVID-19 and in historical controls with similar comorbidities (n=266) who had undergone echocardiography before the COVID-19 pandemic. In patients with COVID-19, EF1 was a strong predictor of survival in each patient group (Wuhan and London). In the combined group, EF1 was a stronger predictor of survival than other clinical, laboratory, and echocardiographic characteristics including age, comorbidities, and biochemical markers. A cutoff value of 25% for EF1 gave a hazard ratio of 5.23 ([95% CI, 2.85–9.60]; P <0.001) unadjusted and 4.83 ([95% CI, 2.35–9.95], P <0.001) when adjusted for demographics, comorbidities, hs-cTnI (high-sensitive cardiac troponin), and CRP (C-reactive protein). EF1 was similar in patients with and without COVID-19 (23.2±7.3 versus 22.0±7.6%, P =0.092, adjusted for prevalence of risk factors and comorbidities). Impaired EF1 is strongly associated with mortality in COVID-19 and probably reflects preexisting, preclinical heart failure.

Abstract 026: Eicosapentaenoic Acid is a Strong Predictor of Risk for Heart Failure in the Multi-ethnic Study of Atherosclerosis

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Robert C Block ◽  
Linxi Liu ◽  
Michael Y Tsai ◽  
Timothy D O'Connell ◽  
Gregory C Shearer
Keyword(s):  
Heart Failure ◽  
Fatty Acids ◽  
Ejection Fraction ◽  
Eicosapentaenoic Acid ◽  
Proportional Hazards ◽  
Strong Predictor ◽  
Cox Proportional Hazards ◽  
Lipid Lowering ◽  
Ethnic Study ◽  
Total Fatty Acids

Introduction: In animal models of afterload stress, eicosapentaenoic acid (EPA) prevents interstitial myocardial fibrosis and preserves diastolic dysfunction. Hypothesis: We hypothesized that EPA is similarly protective in humans. Methods: In the Multi-Ethnic Study of Atherosclerosis, we tested for an effect of plasma phospholipid EPA percent of total fatty acids on primary heart failure incidence across heart failure types including, heart failure with reduced ejection fraction (HFrEF; <45% EF), and with preserved ejection fraction (HFpEF) using Cox proportional hazards modeling in 6566 subjects. Results are mean [95% CI]. Results: A total of 6566 subjects had measured baseline EPA, including 1797 black, 794 Chinese, 1444 Hispanic, and 2531 white participants; 52% were female. Over a median follow-up of 13.0 years, 293 heart failure events occurred in subjects with measured EPA: 129 had HFrEF, 110 had HFpEF, and the remaining 54 had unknown ejection fraction status. Mean EPA in HF-free subjects was 0.77% (0.76 - 0.79), and was lower in heart failure subjects 0.70% (0.65 - 0.74), p=0.002. EPA was associated with lower incidence of HF, having a hazard ratio of 0.73 (0.60 - 0.89) per unit change in percentage of total fatty acids, p=0.001. Adjusting for age, sex, race, BMI, smoking, diabetes mellitus, blood pressure, lipids and lipid-lowering drugs, and albuminuria did not change this relationship. Sensitivity analysis showed no dependence on heart failure type. Adjusting for other fatty acids with clustering did not change hazards. In animals, >2.5% EPA is required for prevention of HF, between 2.5% and 1% is marginal, and <1% EPA is insufficient. Most subjects had insufficient EPA levels (n=4794), fewer had marginal levels (n=1471), and fewer still had sufficient levels (n=301). Subjects with sufficient EPA levels were at 0.40 (0.15 - 0.81) fold risk compared to insufficient EPA (p=0.008). Conclusion: High abundance of EPA is robustly associated with reduced risk for heart failure, independent of established risk factors and regardless of ejection fraction status.

Abstract MP35: Association Of Orthostatic Blood Pressure Response With Incident Heart Failure: The Framingham Heart Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Tara A Shrout ◽  
Vasan S Ramachandran ◽  
Vanessa Xanthakis
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Framingham Heart Study ◽  
Proportional Hazards ◽  
Blood Pressure Response ◽  
The Elderly ◽  
Cox Proportional Hazards ◽  
Heart Study ◽  
Orthostatic Blood Pressure

Introduction: Orthostatic hypotension (OH) and hypertension (OHT) are associated with cardiovascular disease and mortality. The relation of OH and OHT with heart failure (HF) in the community is not well explored, particularly among the elderly and those with hypertension. Moreover, there remains a paucity of longitudinal data on the development of HF subtypes (HF with reduced ejection fraction [HFrEF] and HF with preserved ejection fraction [HFpEF]) in those with OH and OHT. Hypothesis: We hypothesized that OH and OHT are associated with a higher risk of HF. Methods: We evaluated 1914 Framingham Heart Study participants (mean age 72 years, 1159 women [61%]), with available orthostatic blood pressure (BP) measurements. OH was defined as a decrease and OHT as an increase of 20/10 mmHg in systolic/diastolic BP from supine to standing position, respectively. We used a categorical variable (OH, OHT, absence of OH and OHT [referent]). Using Cox proportional hazards regression, we related OH and OHT to risk of HF and its subtypes (HFrEF, HFpEF), compared to the referent group, adjusting for age, sex, body mass index, systolic BP, diastolic BP, hypertension treatment, smoking, and diabetes. Results: There were 275 participants with OH (181 women, 66%) and 411 with OHT (236 women, 57%). On median follow-up of 13 years, 492 developed HF (292 women, 59%). In multivariable-adjusted analyses, OH was associated with higher risk of HF (Hazards Ratio [HR] 1.47; 95% CI, 1.13-1.92; Figure ) compared to referent. Further, OH was associated with higher risk of HFrEF (HR 2.56; 95% CI, 1.46-4.48), but not HFpEF. OHT was not associated with incident HF. Conclusions: Assessment of orthostatic BP response in the elderly may identify future HF risk. Further studies are warranted to investigate mechanisms underlying the observed associations.

P1666Do beta-blockers increase the risk for hospitalizations in heart failure with preserved ejection fraction? A secondary analysis of beta-blocker use in the TOPCAT trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D N Silverman ◽  
T B Plante ◽  
M I Infeld ◽  
S P Juraschek ◽  
G Dougherty ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Beta Blocker ◽  
Proportional Hazards ◽  
Beta Blockers ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Reduced Ejection Fraction

Abstract Background The use of beta-blockers for treatment of heart failure (HF) with a reduced ejection fraction (EF) is unequivocally beneficial, but their role in the treatment of preserved EF (HFpEF) remains unclear. Purpose In a contemporary HFpEF cohort, we sought to assess the association of HF hospitalizations and the use of beta-blockers in patients with an EF above and below 50%. Methods The TOPCAT trial tested spironolactone vs. placebo among patients with HFpEF, including some with mild reductions in EF between 45–50%. The primary outcome was a composite of cardiovascular (CV) mortality, aborted cardiac arrest, or HF hospitalizations. Medication use, including beta-blockers, was reported at each visit and hospitalization. In the 1,761 participants from the Americas, we compared the association of beta-blocker use (vs. no use) and HF hospitalization or CV mortality using Cox proportional hazards models adjusted for baseline demographics, history of myocardial infarction, atrial fibrillation, chronic obstructive pulmonary disease, asthma, and hypertension. The analyses were repeated in the EF strata ≥50% and <50%. Results Among patients included in the current analysis (mean age 72 years, 50% female, 78% white), 1,496/1,761 (85%) received beta-blockers and 1,566/1,761 (89%) had an EF ≥50%. HF hospitalizations and CV mortality occurred in 399/1,761 (23%) and 223/1,761 (13%) of participants, respectively. Beta-blocker use was associated with an increase in risk of HF hospitalization among patients with preserved EF ≥50% [HR 1.56, (95% CI 1.09–2.24), p=0.01] and was associated with a reduction in risk of hospitalization in patients with an EF <50% [HR 0.42, (95% CI 0.18- 0.99), p<0.05]. We found a significant interaction for EF threshold and beta-blocker use on incident HF hospitalizations (p=0.01). There were no differences in CV mortality. Figure 1. Kaplan Meier incidence plots Conclusions Beta-blocker use was associated with an increase in HF hospitalizations in patients with HFpEF (EF≥50%) but did not affect CV mortality. Further research is needed to confirm these findings and elucidate causality.

scholarly journals Routinely reported ejection fraction and mortality in clinical practice: where does the nadir of risk lie?

2019 ◽  
Author(s):  
Gregory J Wehner ◽  
Linyuan Jing ◽  
Christopher M Haggerty ◽  
Jonathan D Suever ◽  
Joseph B Leader ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Proportional Hazards ◽  
Patient Characteristics ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Left Ventricular Ejection ◽  
Validation Dataset ◽  
Ventricular Ejection Fraction ◽  
Hazard Ratios

Abstract Aims We investigated the relationship between clinically assessed left ventricular ejection fraction (LVEF) and survival in a large, heterogeneous clinical cohort. Methods and results Physician-reported LVEF on 403 977 echocardiograms from 203 135 patients were linked to all-cause mortality using electronic health records (1998–2018) from US regional healthcare system. Cox proportional hazards regression was used for analyses while adjusting for many patient characteristics including age, sex, and relevant comorbidities. A dataset including 45 531 echocardiograms and 35 976 patients from New Zealand was used to provide independent validation of analyses. During follow-up of the US cohort, 46 258 (23%) patients who had undergone 108 578 (27%) echocardiograms died. Overall, adjusted hazard ratios (HR) for mortality showed a u-shaped relationship for LVEF with a nadir of risk at an LVEF of 60–65%, a HR of 1.71 [95% confidence interval (CI) 1.64–1.77] when ≥70% and a HR of 1.73 (95% CI 1.66–1.80) at LVEF of 35–40%. Similar relationships with a nadir at 60–65% were observed in the validation dataset as well as for each age group and both sexes. The results were similar after further adjustments for conditions associated with an elevated LVEF, including mitral regurgitation, increased wall thickness, and anaemia and when restricted to patients reported to have heart failure at the time of the echocardiogram. Conclusion Deviation of LVEF from 60% to 65% is associated with poorer survival regardless of age, sex, or other relevant comorbidities such as heart failure. These results may herald the recognition of a new phenotype characterized by supra-normal LVEF.

Abstract MP34: The Association Between Periodontal Disease And Incident Heart Failure: The Atherosclerosis Risk In Communities Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Rebecca L Molinsky ◽  
Faye L Norby ◽  
Bing Yu ◽  
Amil M Shah ◽  
Pamela L Lutsey ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Periodontal Disease ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Atherosclerosis Risk In Communities ◽  
Increased Risk ◽  
Atherosclerosis Risk ◽  
Incident Heart Failure

Introduction: Periodontal disease, resulting from inflammatory host-response to dysbiotic subgingival microbiota, has been associated with incident hypertension, heart attack, stroke and diabetes. Limited data exist investigating the prospective relationship between periodontal disease and incident heart failure (HF) and HF subtypes. We hypothesize that periodontal disease is associated with increased risk for heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Methods: We studied 6,707 participants enrolled in the Atherosclerosis Risk in Communities Study who received a full-mouth clinical periodontal examination at visit 4 (1996-1998) and had longitudinal follow-up starting in 2005. Participants were classified as being periodontally healthy, having periodontal disease (based on the Periodontal Profile Classification (PPC)), or being edentulous. Hospitalization records were reviewed, and HF events were adjudicated and classified as HFpEF, HFrEF or HF of unknown ejection fraction (HFunknownEF) from 2005-2018. We used multivariable-adjusted Cox proportional hazards models to assess the association between periodontal disease or edentulism and incident HF. Results: Among participants 58% had periodontitis and 19% were edentulous. During a median follow-up time of 13 years, 1,178 cases of incident HF occurred (350 HFpEF, 319 HFrEF and 509 HFunknownEF). Periodontal disease and being edentulous were both associated with increased risk for both HFpEF and HFrEF (Table). Conclusion: Periodontal disease measured in mid-life was associated with both incident HFpEF and HFrEF. Adverse microbial exposures underlying periodontal disease might represent a modifiable risk factor for inflammation-induced heart failure pathophysiology.

Differential impact of obstructive and restrictive ventilatory patterns on incident heart failure with preserved versus reduced ejection fraction in late-life

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Ramalho ◽  
B.L Claggett ◽  
D.W Kitzman ◽  
P.P Chang ◽  
G Cipriano Junior ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Proportional Hazards ◽  
Late Life ◽  
Health Department ◽  
Cox Proportional Hazards ◽  
Funding Source ◽  
Reduced Ejection Fraction ◽  
Blood Institute ◽  
The Impact

Abstract Background Subclinical pulmonary dysfunction predicts cardiovascular (CV) outcomes, especially heart failure (HF). However, the impact of reduced percent predicted forced vital capacity (ppFVC) and forced expired volume in 1 second (FEV1)/FVC on different incident HF phenotypes in late-life is unclear. Purpose Determine the associations of FEV1/FVC and ppFVC with incident HF with preserved (HFpEF) and reduced (HFrEF) ejection fraction in late-life. Methods In the Atherosclerosis Risk in Communities longitudinal cohort study, 3,854 HF-free participants who underwent echocardiography and spirometry at the fifth study visit (2011–2013). The relation between pulmonary function and incident adjudicated HFpEF and HFrEF were examined using multivariable Cox proportional hazards models adjusted for demographics, body mass index, coronary artery disease, atrial fibrillation, hypertension, diabetes, and NT-proBNP. Results Mean age was 75±5 years, 40% were male, 19% black, and 6% current smokers. Mean FEV1/FVC was 72±8, and ppFVC was 98±17%. At a median follow-up of 5.6 years, lower ppFVC was independently associated with incident HFpEF, but not HFrEF (Table). Lower FEV1/FVC ratio was associated with higher risk of incident HFrEF but not HFpEF in models adjusted for demographics, which did not persist after further adjustment for clinical risk factors. Conclusion The relationships of reduced ppFVC and FEV1/FVC with incident HF differ significantly by HF phenotype. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services

scholarly journals Blood Pressure and Safety Events With Vericiguat in the VICTORIA Trial

2021 ◽  
Author(s):  
Carolyn S. P. Lam ◽  
Hillary Mulder ◽  
Yuri Lopatin ◽  
Jose B. Vazquez‐Tanus ◽  
David Siu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Proportional Hazards ◽  
Study Drug ◽  
Cox Proportional Hazards ◽  
Angiotensin Receptor ◽  
Unique Identifier ◽  
Reduced Ejection Fraction ◽  
Over Time

Background Although safety and tolerability of vericiguat were established in the VICTORIA (Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction) trial in patients with heart failure with reduced ejection fraction, some subgroups may be more susceptible to symptomatic hypotension, such as older patients, those with lower baseline systolic blood pressure (SBP), or those concurrently taking angiotensin receptor neprilysin inhibitors. We described the SBP trajectories over time and compared the occurrence of symptomatic hypotension or syncope by treatment arm in potentially vulnerable subgroups in VICTORIA. We also evaluated the relation between the efficacy of vericiguat and baseline SBP. Methods and Results Among patients receiving at least 1 dose of the study drug (n=5034), potentially vulnerable subgroups were those >75 years old (n=1395), those with baseline SBP 100–110 mm Hg (n=1344), and those taking angiotensin receptor neprilysin inhibitors (n=730). SBP trajectory was plotted as mean change from baseline over time. The treatment effect on time to symptomatic hypotension or syncope was evaluated overall and by subgroup, and the primary efficacy composite outcome (heart failure hospitalization or cardiovascular death) across baseline SBP was examined using Cox proportional hazards models. SBP trajectories showed a small initial decline in SBP with vericiguat in those >75 years old (versus younger patients), as well as those receiving angiotensin receptor neprilysin inhibitors (versus none), with SBP returning to baseline thereafter. Patients with SBP <110 mm Hg at baseline showed a trend to increasing SBP over time, which was similar in both treatment arms. Safety event rates were generally low and similar between treatment arms within each subgroup. In Cox proportional hazards analysis, there were similar numbers of safety events with vericiguat versus placebo (adjusted hazard ratio [HR], 1.18; 95% CI, 0.99–1.39; P =0.059). No difference existed between treatment arms in landmark analysis beginning after the titration phase (ie, post 4 weeks) (adjusted HR, 1.14; 95% CI, 0.93–1.38; P =0.20). The benefit of vericiguat compared with placebo on the primary composite efficacy outcome was similar across the spectrum of baseline SBP ( P for interaction=0.32). Conclusions These data demonstrate the safety of vericiguat in a broad population of patients with worsening heart failure with reduced ejection fraction, even among those predisposed to hypotension. Vericiguat’s efficacy persisted regardless of baseline SBP. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02861534.

Abstract 13885: Phenotyping Risk Profiles for Heart Failure With Preserved and Reduced Ejection Fraction Among Breast Cancer Survivors

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Alexi Vasbinder ◽  
Richard Cheng ◽  
Roberta Ray ◽  
Dale Langford ◽  
Ana Barac ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Breast Cancer Survivors ◽  
Proportional Hazards ◽  
Lifestyle Factors ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Increased Risk

Introduction: Breast cancer (BC) survivors (BCS) are at increased risk for incident heart failure (HF). In this population, the risk for HF with preserved ejection fraction (HFpEF) has been understudied compared to HF with reduced EF (HFrEF). The purpose of this study was to estimate 1) the incidence of HFpEF and HFrEF, and 2) the phenotypic profiles conferring risk for incident HFpEF and HFrEF in BCS. Methods: This Women’s Health Initiative analysis was conducted in women with invasive BC stages I-IV in the Medical Records Cohort (MRC). Those with pre-existing HF were excluded. Exposures of interest were lifestyle factors [e.g. body mass index (BMI)], comorbidities [e.g. hypertension, diabetes, and myocardial infarction (MI)], and BC treatment. Lifestyle factors and comorbidities most proximal and prior to BC diagnosis were assessed. In the MRC, BC and HF as well as left ventricular EF (LVEF) were ascertained through chart review and physician-adjudication. LVEF ≥50% was classified as HFpEF; and <50% for HFrEF per AHA/ACC guidelines. Cox proportional hazards models estimated risks of HFpEF and HFrEF. Follow up time began at BC diagnosis and HF events were recorded through March 1, 2019. All models adjusted for age at BC diagnosis. Results: In 2,250 BCS, 153 developed HF after BC during a median follow-up of 7.3 years. Of those, 49 had HFrEF and 75 had HFpEF. The cumulative incidences of HFrEF and HFpEF over follow-up were 7.3% and 4.6%, respectively. Diabetes and MI were associated with both HFpEF and HFrEF (Table). Smoking, BMI ≥30, and hypertension were associated with HFpEF. Anthracycline use was associated with HFrEF but not HFpEF (p=0.03). Conclusions: In BCS, lifestyle factors were associated with incident HFpEF, whereas anthracycline use was associated with a higher risk for HFrEF. Understanding risk factors associated with incident HFpEF and HFrEF in BCS is important to guide the implementation of risk profile-specific preventative measures and interventions.

Abstract 11: Prospective Association of Tet2 Mediated Clonal Hematoopoiesis and Heart Failure and Its Subtypes in Postmenopausal Women

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Chuck Eaton ◽  
Laura M Raffield ◽  
Alexander Bick ◽  
Mary Roberts ◽  
Joann E Manson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ejection Fraction ◽  
Postmenopausal Women ◽  
Somatic Mutations ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model

Background: Recent studies have shown that hematopoietic stems cells can undergo clonal expansion secondary to somatic mutations, termed clonal hematopoiesis of indeterminate potential (CHIP). TET2 is frequently mutated in individuals with CHIP and has been associated with coronary heart disease in humans and Heart Failure in mice models. We investigated whether any of the top three somatic mutations ( DNMT3A,TET2, ASXL1) associated with CHIP were prospectively associated with heart failure (HF), heart failure with preserved ejection fraction (HFPEF) or heart failure with reduced ejection fraction (HFrEF) in post menopausal women. Methods: A subcohort of 5214 postmenopausal women in the Women’s Health Intiative were evaluated for CHIP and HF. CHIP was determined at the Broad Institute via whole genome sequencing using the GATK4 MuTect2 somatic variant caller through the NHLBI TOPMed project. Hospitalized heart failure was based upon trained physician record review. HFpEF was defined as an EF > 50% and HFrEF as EF<50% . Cox proportional hazards model were evaluate adjusting for age, race, income, education, cigarette smoking, body mass index, coronary heart disease, atrial fibrillation, diabetes , hypertension, systolic blood pressure, and stroke. Inverse probability weighting was used to account for selection bias associated with the subcohort selection. Results: Of the 5214 postmenopausal women, 597 developed HF, 283 HFpEF and 204 HFrEF. N=408 had CHIP. The top 3 gene mutations associated with CHIP (N=364) were DNMT3A (4.8%), TET2 (1.7%) and ASXL1 (0.5%). Women with CHIP associated with any of the top 3 mutations and with TET2 were associated with HF, HFpEF but not HFrEF. DNMT3A and ASXL1 CHIP mutations were not associated HF, HFpEF or HFrEF (See Table ). Conclusion: CHIP associated with the top 3 somatic mutations and TET2 were prospectively associated with HF and HFpEF consistent with animal models and the concept of HFpEF being associated with pathologic aging. Replication of these findings in other cohorts is warranted.

Abstract 15191: Left Atrial Volume as an Independent Predictor of Congestive Heart Failure in Patients With Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yoshinobu Suwa ◽  
Yoko Miyasaka ◽  
Satoshi Tsujimoto ◽  
Hirofumi Maeba ◽  
Ichiro Shiojima
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Proportional Hazards ◽  
Left Atrial Volume ◽  
Cox Proportional Hazards ◽  
History Of ◽  
Lv Ejection Fraction

Backgound: Left atrial (LA) enlargement has been proposed as a barometer of diastolic dysfunction and a predictor of congestive heart failure (CHF) in patients with sinus rhythm. Whether LA volume predicts CHF in patients with atrial fibrillation (AF) is not well known. Methods: To determine the clinical importance of LA volume in the prediction of CHF in patients with AF, AF patients referred for clinically-indicated echocardiogram, without a history of significant mitral valve disease, congenital heart disease, pacemaker, or cardiac surgery, in 2007-2008 were prospectively included and followed forward them up to September 2014. LA volume was measured using the biplane area-length formula. CHF was ascertained using the Framingham criteria. Cox proportional hazards modeling was used to assess the risk factors of CHF development. Results: Of 456 AF patients who met all study criteria (mean 70 ± 10 year-old, 67% men, 62% hypertension, 26% diabetes, LV ejection fraction 68 ± 13%, LA volume 52 ± 24 mL/m 2 ), 46 (10%) developed CHF events during a mean follow-up of 44 ± 31 months. CHF events were significantly increased with advancing age (HR 1.4, 95%CI 1.0-2.0, P<0.05), but not with sex. In a multivariate Cox proportional hazards model, greater indexed LA volume (per 10 mL/m 2 ; HR 1.2, 95% CI 1.1-1.3, P<0.01) was independent of age (HR 1.04, 95% CI 1.01-1.07, P=0.03), sex (P=0.77), history of CHF (P=0.58), hypertension (P=0.38), diabetes (P=0.89), and LV ejection fraction (HR 0.95, 95% CI 0.93-0.96, P<0.001) for the prediction of CHF development. The Kaplan-Meier estimate of cumulative CHF-free survival by indexed LA volume was shown (Fig.). Conclusions: In our cohort with AF, LA volume predicted CHF developments, independent of LV systolic function and other cardiovascular comorbidities, which appears to be clinically useful information for risk stratification.

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